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Hello group - I had a sleep study in 2007 while on active duty and got diagnosed with "mild obstructive sleep apnea." There was no treatment provided/necessary. I retired from the Navy in 2017 after 25 years of active duty and submitted the sleep study in my claim. Unfortunately, I did not have documented proof of hypersomnolence. In May 2018 I had another sleep study with the result being "severe obstructive sleep apnea," and was prescribed a CPAP which I use currently. This particular evidence was not submitted in my claim package. I just received my VA decision letter on 10/4/18, the VA assigned a disability rating of 0% for the apnea (as expected), but listed it as "service connected." My question is this: I have the medical evidence now to prove I have severe apnea and I'm getting ready to submit a NOD. Do I have to also prove "service connectivity?" or has this been sufficiently established and cannot be taken away by the DRO? Also, do I have to provide evidence that I had hypersomnolence from 2007 to 2018 to prove it's all connected? This will be the tough part for me. It seems pretty straight forward, but I know nothing is ever a slam dunk in this arena so what am I potentially missing? Thanks! Joe

Looking at the results in my file from the C&P. Does this look favorable? I know the degree of anything awarded goes off other particulars ect. RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Is Veteran's sleep disturbance secondary to his stress related disorder? b. Indicate type of exam for which opinion has been requested: psychological TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not ( 50% or greater probability) proximately due to or the result of the Veteran's service connected condition. ******************************** Intestinal Conditions (other than surgical or infectious), including irritable bowel syndrome, Crohn's disease, ulcerative colitis and diverticulitis Disability Benefits Questionnaire 11. Remarks, if any: -------------------- GULF WAR STATEMENT: In reviewing electronic files in VBMS and CPRS in conjunction with today's examination, the Veteran has a diagnosable, but medically unexplained illness of unknown etiology. * The disability pattern most closely correlates with a diagnosed illness of unknown etiology. * He indicates he has intermittent episodes of diarrhea/constipation/bloating and pain. * It is my medical opinion that this condition at least as likely as not (50 percent or greater probability) qualifies as a presumptive condition from service in SouthWesttAsia per website http://www.publichealth.va.gov/exposures/gulfwar/medically- unexplained-il lness. *************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA AT LEAST AS LIKELY AS NOT 950 PERCENT OR GREATER PROBABILITY) RELATED TO OR INCURRED DURING HIS MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: OSA TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ******************************* RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S ERECTILE DYSFUNCTION AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) PROXIMATELY DUE TO OR RELATED TO THE MEDICATION (PROZAC) USED TO TREAT HIS SERVICE CONNECTED MENTAL HEALTH CONDITION? b. Indicate type of exam for which opinion has been requested: ED TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition. *************************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF SPERMATOCELE AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) RELATED TO THE TESTICULAR PAIN DURING ACTIVE MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: SPERMATOCELE TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ***************************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF PATELLOFEMORAL SYNDROME RIGHT KNEE AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) INCURRED IN OR RELATED TO HIS RIGHT KNEE PFS DURING ACTIVE MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: PATELLOFEMORAL PAIN SYNDROME RIGHT KNEE TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ******************************************* RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CHRONIC CERVICAL STRAIN AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) DUE TO OR THE RESULT OF HIS MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: CHRONIC CERVICAL STRAIN. TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ********************************************** 4. Erectile dysfunction ----------------------- Does the Veteran have erectile dysfunction? [X] Yes [ ] No If yes, complete the following section: a. Etiology of erectile dysfunction: prozac (medication used to treat service connected mental health condition) b. If the Veteran has erectile dysfunction, is it as likely as not (at least a 50% probability) attributable to one of the diagnoses in Section 1, including residuals of treatment for this diagnosis? [X] Yes [ ] No If yes, specify the diagnosis to which the erectile dysfunction is as likely as not attributable:prozac (treatment for service connected mental health condition) ***************************************** GULF WAR STATEMENT: In reviewing electronic files in VBMS and CPRS in conjunction with today's examination, the Veteran has a diagnosable condition (GERD), but medically unexplained illness of unknown etiology. The condition GERD is at least as likely than not (50 percent or greater probability) related to his military service in Southwest Asia. ********************************************

Looking at the results in my file from the C&P. Does this look favorable? I know the degree of anything awarded goes off other particulars ect. RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: Is Veteran's sleep disturbance secondary to his stress related disorder? b. Indicate type of exam for which opinion has been requested: psychological TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not ( 50% or greater probability) proximately due to or the result of the Veteran's service connected condition. ******************************** Intestinal Conditions (other than surgical or infectious), including irritable bowel syndrome, Crohn's disease, ulcerative colitis and diverticulitis Disability Benefits Questionnaire 11. Remarks, if any: -------------------- GULF WAR STATEMENT: In reviewing electronic files in VBMS and CPRS in conjunction with today's examination, the Veteran has a diagnosable, but medically unexplained illness of unknown etiology. * The disability pattern most closely correlates with a diagnosed illness of unknown etiology. * He indicates he has intermittent episodes of diarrhea/constipation/bloating and pain. * It is my medical opinion that this condition at least as likely as not (50 percent or greater probability) qualifies as a presumptive condition from service in SouthWesttAsia per website http://www.publichealth.va.gov/exposures/gulfwar/medically- unexplained-il lness. *************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA AT LEAST AS LIKELY AS NOT 950 PERCENT OR GREATER PROBABILITY) RELATED TO OR INCURRED DURING HIS MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: OSA TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ******************************* RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S ERECTILE DYSFUNCTION AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) PROXIMATELY DUE TO OR RELATED TO THE MEDICATION (PROZAC) USED TO TREAT HIS SERVICE CONNECTED MENTAL HEALTH CONDITION? b. Indicate type of exam for which opinion has been requested: ED TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR SECONDARY SERVICE CONNECTION ] a. The condition claimed is at least as likely as not (50% or greater probability) proximately due to or the result of the Veteran's service connected condition. *************************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF SPERMATOCELE AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) RELATED TO THE TESTICULAR PAIN DURING ACTIVE MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: SPERMATOCELE TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ***************************************** RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CURRENT DIAGNOSIS OF PATELLOFEMORAL SYNDROME RIGHT KNEE AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) INCURRED IN OR RELATED TO HIS RIGHT KNEE PFS DURING ACTIVE MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: PATELLOFEMORAL PAIN SYNDROME RIGHT KNEE TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ******************************************* RESTATEMENT OF REQUESTED OPINION: a. Opinion from general remarks: IS THE VETERAN'S CHRONIC CERVICAL STRAIN AT LEAST AS LIKELY AS NOT (50 PERCENT OR GREATER PROBABILITY) DUE TO OR THE RESULT OF HIS MILITARY SERVICE? b. Indicate type of exam for which opinion has been requested: CHRONIC CERVICAL STRAIN. TYPE OF MEDICAL OPINION PROVIDED: [ MEDICAL OPINION FOR DIRECT SERVICE CONNECTION ] a. The condition claimed was at least as likely as not (50% or greater probability) incurred in or caused by the claimed in-service injury, event or illness. ********************************************** 4. Erectile dysfunction ----------------------- Does the Veteran have erectile dysfunction? [X] Yes [ ] No If yes, complete the following section: a. Etiology of erectile dysfunction: prozac (medication used to treat service connected mental health condition) b. If the Veteran has erectile dysfunction, is it as likely as not (at least a 50% probability) attributable to one of the diagnoses in Section 1, including residuals of treatment for this diagnosis? [X] Yes [ ] No If yes, specify the diagnosis to which the erectile dysfunction is as likely as not attributable:prozac (treatment for service connected mental health condition) ***************************************** GULF WAR STATEMENT: In reviewing electronic files in VBMS and CPRS in conjunction with today's examination, the Veteran has a diagnosable condition (GERD), but medically unexplained illness of unknown etiology. The condition GERD is at least as likely than not (50 percent or greater probability) related to his military service in Southwest Asia. ********************************************

My sleep apena claim, started in Oct 2011 has been approved. My contention was that my apnea is aggravated by my weight caused by inactivity and drugs used for depression and chronic pain. When I get the decision I will analyze it and its relevant notes for the decision to see if I can identify anything that might be helpful to others. I was not diagnosed before discharge with apnea, nor was I receiving treatment in service. I didn't even get checked for it until September of last year, when a CPAP was issued. I've read so much on here about how difficult it is to get sleep apnea service connected, especially if you don't have an in service finding. Here's to hoping that my decision renders some insight into what their rationale was. Many others here and on VPN have tried to service connect apnea with varying degrees of success and failure, but the arrow seems to point more towards failure if there is no in service finding. In True VA Fashion ™ it makes little sense. I submitted all sorts of documentation, because id read on here that it is such an uphill battle to get this service connected especially with no in service diagnosis. My finding letter came, and despite the list of reviewed material, the actual Reasons and Basis is about 2 sentences long: "We have assigned a 50 % evaluation for your obstructive sleep apnea based on: 0-Requires use of breathing assitance device such as continuous airway pressure machine." Thats it, folks. No quoting my material, no quoting of things in my Dr's letter, not quoting of the record itself or the sleep tech's finding. I claimed it secondary to weight gain, pain and inactivity due to chronic pain, depression, and intervertebral disc syndrome. Ill post my Dr's letter below that was submitted. The rest of what I turned in was pretty standard. A statement from my wife, the sleep tech records, there was a C&P that was about 20 minutes long. I had some treatment notes that had been submitted for ED that I mentioned my issues sleeping with her as well, but I can't find those. Mr. Satterfield has been a patient of mine since October of 2000. The conditions that I examined him for are chronic lower back pain and sleep difficulties. I personally reviewed Mr. Satterfield's medical history including his service medical records from April 2001 to February 2002; and his VA rating decision rating decision C-file and C & P final report for service connection for degenerative disc disease dated September July 2002. His contention today is that he is having difficulty sleeping and that his wife says that he stops breathing several times a night during sleep. Mr. Satterfield was prescribed Elavil (10Mg) for sleep difficulties after his injury by Kenner Army Health Clinic, Ft. Lee, VA, and continued to take them after his discharge from service, and also takes Ultram, Flexaril, and Ibuprofen for pain, as prescribed by the VA. Currently he is prescribed Hydrocodone, Meloxicam, Gabapentin, Temazepam, Seretraline, and Omeprazole. It is my opinion that it is likely that Mr. Satterfield’s sleep difficulties are aggravated by his service connected degenerative disc disorder and chronic pain, and the weight gained because of it. I also feel that it is at least as likely as not that Mr. Satterfield’s continued obesity is aggravated by his service connected degenerative disc disorder and pain, since his continued efforts to consume fewer calories over several months have resulted in very little loss. Sleep disruption caused by obstructive sleep apnea can certainly be exacerbated by certain narcotic pain medicines, SSRI’s, and increasing weight. Mr. Satterfield has no prior symptoms of thyroid or metabolic issues, and had no reported sleep difficulties or weight related health problems prior to enlisting into the Army in April of 2001. He has been eating below maintenance for his weight and build, but continues to have difficulty losing weight. Because of these things, and the observations of his spouse it is likely that Mr. Satterfield has undiagnosed obstructive sleep apnea with an onset that started after his service connected injury and the weight gained as a side effect. Sincerely, CLAIM: Sleep Apnea W/CPAP secondarily aggravated by medications, pain, obesity, and depression due to service connected lower back injury. In Aug 2001 I was diagnosed with a lower back trauma that was LOD directly to an injury incurred during training at Ft. Jackson SC. At that time I was still actively serving, under profile with a weight of 192-195 lbs. I was transferred to Ft. Lee, VA for AIT to await a decision about a MEB/PEB. As I was under strict PT restrictions and duty restrictions, and in a state of constant (albeit treated) pain, my activity level plummeted and my weight started to increase. Being that I was in a training environment at Ft. Lee my diet and activities were still restricted as that of any other trainee. I left Ft. Lee in January of 2002, still just under 200 lbs. In the later part of 2001 I was prescribed Elevil to help with sleep disturbance issues by either Doctor _________ (Kenner Army Health Clinic) or Dr. ________(Kenner Army Health Clinic). I was not diagnosed with sleep difficulties prior to this time-having been married before enlistment, this would have been noticed by my wife. This prescription for elavil was filled to excess before I processed out of Ft. Lee, VA so that I would have time to set up civilian or VA health care. I continued to take Elavil for sleep disturbances, along with Ultram, Flexaril and Ibuprofen for pain until my prescriptions ran out a few months later. In that time I received a C&P for my lower back injury which was ruled service connected. During this time my weight continued to increase due to inactivity and pain. In my initial C&P examination by PA-C J_______ I was noted to be obese 4/29 /02. In December of 2002 . I sawcivilian _________ Medical center (Dr. _____) to refill current medications for pain and sleep issues, including elavil. In a later examination by PA-C __________, Lincoln VAMC I was noted in January 2003 to weigh 257 lbs when I saw him about pain and medications for pain. I declined to add elavil to my VA medications at that time, hoping that my sleep issues would work themselves out with better pain management. My psychology treatment records by Dr. R_______ indicate sleep disturbances, and my struggles with weight loss/gain as well, and they are incorporated into my overall rating for depression. Inactivity due to pain is also noted throughout, and prior history is established that I was active prior to military service (theater/music) and obviously during service until my injury. I currently weight (10/15/2011) 312 lbs. Post service I have struggled with my weight due to inactivity or due to medications taken for pain that have side effects of weight gain. I may lose 5-10 lbs on a severely restricted diet, or an increase in activity, but pain, motivation issues, and depression issues cause me to gain it back. I take one medication, Hydrocodone, in a direct attempt to BECOME more active to try to lose weight but thus far it’s results are unquantifiable because of the myriad other issues contributing to my weight. In October of 2011 I was diagnosed at the Omaha VA Hospital with Sleep Apnea, and, on the basis of the sleep study, issues a CPAP machine (thank you!) This has helped control my apneic sleep disturbances that I feel are a result of my weight gain from my medications, depression, and lower back injury. It may be that since Elavil was not prescribed until after my injury in 2001 that the beginnings of sleep apnea extend to that point where I started to gain weight before discharge from the Army, and have steadily increased since. PA-C D_______ (Omaha VAMC) opined during counseling that Sleep Apnea is a result of either genetics/physical jaw issues, medications, Psychological issues (PTSD, etc), or obesity, and that it can be caused by, or CAN contribute to obesity and depression, and that my issues with both most likely come at least in part, from this etiology. He also advised to “avoid etoh/sedative/narcotics (do not increase hydrocodone dosage)”. His advisement directly contravenes my attempts to be more active to lose weight, by reducing the options available to me for pain management. However, dying slowly in my sleep is not an attractive option, either, and so I am inclined to follow his reasoning. In doing so, however, I must limit my activity. My psychology treatment records, military medical records, and treatment records from Lincoln VAMC are in my CFile. My consult from Johnson County Medical Center is in my CFile. My Omaha records from my sleep study are in VISTA. Please find and adjudicate accordingly. Per prior rulings by the DVA, with sufficient evidence, Sleep Apnea post discharge has been granted service connection in cases as secondary to obesity , MH issues, and medication when one or more of those are service connected. Citation Nr: 0905272 Decision Date: 02/13/09 Archive Date: 02/19/09 DOCKET NO. 04-16 673A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida Thank you. Here is what I filed:

I have a claim in for serveral disabilities. I'm on step 5 ( I think that's preparation for decision). Not taking this serious but I know some of you are really good at this by now so if anyone would like to take a crack at what you think my rating will be I'm interested in hearing it! here is a list of my disabilities that are on ebenefits: 1. Sleep apnea w/CPAP (sleep study on file) (New), Had the CPAP almost 2 years now, did 3 sleep studies to get it. 2. Bilateral heel spurs (New), (Dr.s while I was active duty said they were freakin huge, same with the VA doc) 3. Bilateral ankle instability (New), (related to the heel spurs/achilles tendon and plantar fasciitis) 4. Bilateral knee condition (New), (they click and pop all the time even when moved at rest) 5. Bilateral foot plantar fasciitis (New), (VERY high arches, I have insoles that were made for me before I separated) 6. Bilateral Shin splints w/stress Fx (New), (don't know why this would make the list I thought everyone gets these) 7. Bilateral achilles chronic pain on motion, Haylund deformity (New), (high arches make me step weird causes tendon to not line up properly and slide off those spurs metioned earlier, not cool) 8. Lumbar spine pain on motion, bilateral radiculopathy (New), (this can be chalked up now to sciatica in my opinion unless they found something on the xrays that I never heard about) 9. Bilateral hip condtion (New), (more so the left side of the hip than the right but right where the joint for where the leg connects painful numbing kind of sensation and a squishy/grinding sound) 10. Erectile dysfunction (New), (I know this is 0, moving on) 11. Cervical spine condition, (New), (limited range of motion at certain angles) 12. Bilateral shoulder condition; impingement (New), (to add to this, on initianl appt for VA doc noted both rotator cuffs grind and pop at certain points) 13. Residuals of left hand cyst excision (New), (hurts a bit where they cut it out, right in the crease of the wrist behind the thumb) 14. Right wrist numbness (New), (there's the carpe tunnel, has gotten much worse too, thumb goes numb or i lose control of it lol) 15. GERD (New), (I take 40mg of Nexium once a day, twice as needed as prescribed by doctor if I don't stomach pain is extreamly painful, will literally bowl me over and I'm worthless like i'm getting eaten from inside) 16. Hearing loss (New), (hearing test appt for VA showed my hearing is pretty good so maybe disregard) 17. Tinnitus (New), (ears ring) 18. Deviated septum; left (New), (almost completely blocks up left nostril) 19. Tachycardia pulse (New), (fast irregular heartbeat discovered while doing tests for ED meds) 20. Bilateral eye corneal scars, blephartitis floaters (New), 21. Dermatomycossi, tinea versacolor (New) also noted during my initial VA appoint the doc took down that I have Carpe Tunnel and Lateral Epicondylitis (Tennis Elbow) a few of those like the Ed and Tinea i think i've seen a lot of people getting 0% ratings so I didn't factor them in but I used the disability calculator at VV arizona and put in the sleep apena cause its the only one that had a clear rating on the regulations instruction and played with estimates for some of the others, worst case scenario I could come up with was 60% and best case I got 90% I refuse to believe I could get a 100 out of it haha. anyway what you guys think?